Provider Demographics
NPI:1467897397
Name:SMITH-ANDERSEN, LISELOTTE (PT)
Entity type:Individual
Prefix:
First Name:LISELOTTE
Middle Name:
Last Name:SMITH-ANDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 1ST ST SW STE 2
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4427
Mailing Address - Country:US
Mailing Address - Phone:540-980-5000
Mailing Address - Fax:540-985-0529
Practice Address - Street 1:1015 1ST ST SW STE 2
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4427
Practice Address - Country:US
Practice Address - Phone:540-985-0500
Practice Address - Fax:540-985-0529
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist